Provider Demographics
NPI:1265417000
Name:KONG, JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9402 ROWAN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5212
Mailing Address - Country:US
Mailing Address - Phone:713-774-2035
Mailing Address - Fax:713-652-3922
Practice Address - Street 1:955 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-6308
Practice Address - Country:US
Practice Address - Phone:713-652-2010
Practice Address - Fax:713-652-3922
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4285T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPO 80881E8Medicaid
TX82122EOtherBCBS PROVIDER NUMBER
TXPO 82122E3Medicaid
TX82122EOtherBCBS PROVIDER NUMBER
TXPO 80881E8Medicaid